Nightingale's Environment Theory

As the founder of modern nursing, Florence Nightingale’s Environment Theory changed the face of nursing practice. She served as a nurse during the Crimean War, at which time she observed a correlation between the patients who died and their environmental conditions. As a result of her observations, the Environment Theory of nursing was born. Nightingale explained this theory in her book, Notes on Nursing: What it is, What it is Not. The model of nursing that developed from Nightingale, who is considered the first nursing theorist, contains elements that have not changed since the establishment of the modern nursing profession. Though this theory was pioneering at the time it was created, the principles it applies are timeless.

There are seven assumptions made in the Environment Theory, which focuses on taking care of the patient’s environment in order to reach health goals and cure illness. These assumptions are:

  1. natural laws
  2. mankind can achieve perfection
  3. nursing is a calling
  4. nursing is an art and a science
  5. nursing is achieved through environmental alteration
  6. nursing requires a specific educational base
  7. nursing is distinct and separate from medicine

The focus of nursing in this model is to alter the patient’s environment in order to affect change in his or her health. The environmental factors that affect health, as identified in the theory, are: fresh air, pure water, sufficient food supplies, efficient drainage, cleanliness of the patient and environment, and light (particularly direct sunlight). If any of these areas is lacking, the patient may experience diminished health. A nurse’s role in a patient’s recovery is to alter the environment in order to gradually create the optimal conditions for the patient’s body to heal itself. In some cases, this would mean minimal noise and in other cases could mean a specific diet. All of these areas can be manipulated to help the patient meet his or her health goals and get healthy.

The Environment Theory of nursing is a patient-care theory. That is, it focuses on the care of the patient rather than the nursing process, the relationship between patient and nurse, or the individual nurse. In this way, the model must be adapted to fit the needs of individual patients. The environmental factors affect different patients unique to their situations and illnesses, and the nurse must address these factors on a case-by-case basis in order to make sure the factors are altered in a way that best cares for an individual patient and his or her needs.

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The ten major concepts of the Environment Theory, also identified as Nightingale’s Canons, are:

  1. Ventilation and warming
  2. Light and noise
  3. Cleanliness of the area
  4. Health of houses
  5. Bed and bedding
  6. Personal cleanliness
  7. Variety
  8. Offering hope and advice
  9. Food
  10. Observation

According to Nightingale, nursing is separate from medicine. The goal of nursing is to put the patient in the best possible condition in order for nature to act. Nursing is “the activities that promote health which occur in any caregiving situation.” Health is “not only to be well, but to be able to use well every power we have.” Nightingale’s theory addresses disease on a literal level, explaining it as the absence of comfort.

The environment paradigm in Nightingale’s model is understandably the most important aspect. Her observations taught her that unsanitary environments contribute greatly to ill health, and that the environment can be altered in order to improve conditions for a patient and allow healing to occur.

Nightingale’s Modern Nursing Theory also impacted nursing education. She was the first to suggest that nurses be specifically educated and trained for their positions in healthcare. This allowed there to be standards of care in the field of nursing, which helped improve overall care of patients.